In order to facilitate the viewing and analysis of biomedical images, the Clinical Center is in the process of designing and developing an Image Management System (IMS) to complement the current text-based Medical Information System (MIS) . This new system will consist of the following four key components: (1) several different types of medical image gateways (MIG), (2) an image archival and retrieval system (IARS) that has a MIS interface, (3) several different types of workstations (WS) possessing a common biomedical shell, and (4) an interconnecting communications network. The MIGs will permit digital radiological images (i.e. MR, CT, PET, etc.), non-digital radiological images (i.e. plane-film X-ray), and non-radiological images (i.e. video-microscopic images, EKG tracings, patient monitor information etc.) to be converted to a common format, compressed in a loss-less manner, and automatically sent to the IARS. The IARS will permit not only the long term archiving on optical media of the images coming from the MIGs but also the retrieval of multiple modality images to local workstations in response to queries via the existing MIS data-base, the new IMS data-base, or individual departmental data-bases. In the workstation area, we will be developing two or three different types of biomedical workstations. The first is a low-cost WS that is capable of seamlessly accessing both MIS and IMS, that is, display both MIS-based text imformation and IMS-based images, and would be sufficiently cost effective to replace the current MIS units throughout the CC. This low-end WS could be based upon a stripped PC or, possibly, an X-windows terminal. The second type of WS is a medium range unit that would be suitable for the desktop of a physician, scientist, etc. This unit, will probably be based upon a Mac II and would serve the needs of its owner (e.g. word processing, spreadsheets, etc.) by having some local processing and disk storage capability in addition to being able to access both MIS and IMS. It will have image processing power to the extent that images from multiple modalities can be extensively manipulated in 2-D (i.e. window, level, zoom, pan, filters, region of interest, etc.) and possibly also 3-D. The third, or high end, WS will be capable of full 3-D image manipulation and have enough local storage to hold multiple sets of images. The key to this series of workstations is that they would utilize the same biomedical shell (i.e. user interface) . Application programs for diagnostic imaging, stereotaxic surgical planning, radiation therapy planning, tumor staging, etc. will also be developed.